Psoriatic Arthritis.
Last updated Monday, December 27, 2004
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Management and treatment
Treatment
Treatment for psoriatic arthritis depends on how severe your condition is and what areas of the body are affected.
The goals of treatment are to reduce joint
pain and swelling, control the skin patches, and to slow down or
prevent joint damage. Treatment may include one or a combination of
skin care, medications, and other treatments.
Self-management
Take good care of your skin, especially during the winter. This can
help reduce the dryness and skin sores caused by the psoriasis. Keep
your skin from becoming dry by following these tips:
- Use a lotion or lanolin cream.
- Use non-deodorant soaps.
- Put baby oil in your bath water or rub it on your skin after showering.
- Use a humidifier in the winter.
- Avoid using strong soaps or chemicals.
Sit in the sun for moderate periods of time. Because sunlight slows
down cell growth, it can help improve your psoriasis. Too much sunlight
can damage your skin, however, so take steps to avoid sunburn.
Psoralen and ultraviolet light, type A (PUVA) is a combination of
medicine (psoralen) and light (type A ultraviolet light) that can help
clear up skin problems and some joint problems. For this treatment, you
are given psoralen in pill form. This makes your skin sensitive to
ultraviolet light, type A. Then you are exposed to ultraviolet light
for several minutes. You may need at least 20-30 treatments over
several weeks. Talk to your dermatologist (skin doctor) about the
benefits and side effects of this treatment.
Corticosteroid
or steroid creams can be very effective but should be used under the
direction of your health care provider. The more powerful creams can
cause atrophy or thinning of the skin if used improperly. There are
also vitamin D based creams that can be used by some people.
Health care team
People with psoriatic arthritis may be treated by their family doctor,
a skin specialist (dermatologist) or an arthritis specialist
(rheumatologist). The type of doctor you see will depend on your
symptoms. Other health care workers, such as a nurse, occupational
therapist, or physical therapist may also help you manage your
condition.Exercise and therapy
Exercise
The pain and swelling of arthritis can make your joints stiff and hard
to move. If this happens, your doctor or physical therapist may
recommend special exercises to keep your joints strong and flexible. In
addition, general exercise, such as walking, can help improve your overall health.
Rest
Generally, a normal amount of rest and sleep will be enough for you. In
a very few people, however, psoriatic arthritis may cause extreme fatigue.
If this happens, you may need to rest more than usual and learn how to
use your energy wisely throughout your daily activities.
Medications
Some medications
can help relieve joint pain and swelling and can help slow down the
joint damage. Your health care provider may recommend one of the
following:
- Nonsteroidal anti-inflammatory drugs (NSAIDs):
These help reduce mild joint pain and swelling. You may need to take
these for a few days or weeks or for a longer time, depending on your
condition. Examples include ibuprofen and aspirin.
- Corticosteroids:
These are synthetics forms of a hormone your body makes. They are
sometimes helpful when injected into a painful joint and can be used in
small doses by mouth. Reducing your dose of these medicines too quickly
may cause the skin disease to become much worse.
- Sulfasalazine: This is a medication developed to treat rheumatoid arthritis and can be very helpful in people with arthritis. It does not treat the skin disease.
- Methotrexate: This is a very powerful medicine. It can help slow
down the disease and prevent further joint and skin damage in some
cases.
- Cyclosporin A: This is a powerful medicine sometimes used to treat
people who have had organ transplants. In recent studies, it has been
shown effective in treating the skin and joint problems of psoriatic
arthritis. When studies are completed, this medicine may be used to
treat psoriatic arthritis.
- Gold shots: This therapy was first used in people with rheumatoid arthritis but has been successful in psoriatic arthritis as well.
- Etanercept: Still experimental, this agent has been used in people
with psoriatic and psoriasis with success. It is under review of
approval for this disease by the FDA.
These medications work differently in different people. Talk to your
doctor about the risks and benefits of taking these medicines since all
of them have potential side effects. The strongest medications are
reserved for those with the most serious disease.
Surgery
If your joints are severely damaged from psoriatic arthritis, your doctor may recommend joint replacement surgery.
In this surgery, joints damaged by arthritis are replaced with
artificial joints. If this surgery is needed, your doctor will discuss
this with you.Splints or braces
Splints may be useful if you have severe joint problems. Splints help
rest your joints. This helps decrease joint pain, swelling, and
stiffness. Your doctor, physical therapist, or occupational therapist
can help you find the best splint for you.Alternative remedies
Heat and cold treatments
These treatments may help relieve pain and reduce swelling in
your joints. Examples include soaking in a warm tub and placing a
heating pad or cold pack on the painful joint. Talk to your doctor
about what treatments may be best for you.
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